title: Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction.
abstract: BACKGROUND
  The number of patients presenting with acute myocardial infarction (AMI) and being untreatable by interventional cardiologists increased during the last years. Previous experience in emergency coronary artery bypass grafting (CABG) in these patients spurred us towards a more liberal acceptance for surgery. Following a prospective protocol, patients were operated on and further analysed.
  
  
  METHODS
  Within a two year interval, 127 patients (38 female, age 68±12 years, EuroScore (ES) II 6.7±7.2%) presenting with AMI (86 non-ST-elevated myocardial infarction (NSTEMI), 41 STEMI) were immediately accepted for emergency CABG and operated on within six hours after cardiac catheterisation (77% three-vessel-disease, 47% left main stem stenosis, 11% cardiogenic shock, 21% preoperative intraaortic balloon pump (IABP), left ventricular ejection fraction 48±15%).
  
  
  RESULTS
  30-day-mortality was 6% (8 patients, 2 NSTEMI (2%) 6 STEMI (15%), p=0.014). Complete revascularisation could be achieved in 80% of the patients using 2±1 grafts and 3±1 distal anastomoses. In total, 66% were supported by IABP, extracorporal life support (ECLS) systems were implanted in two patients. Logistic regression analysis revealed the ES II as an independent risk factor for mortality (p<0.001, HR 1.216, 95%-CI-Intervall 1.082-1.366).
  
  
  CONCLUSIONS
  Quo ad vitam, results of emergency CABG for patients presenting with NSTEMI can be compared with those of elective revascularisation. Complete revascularisation obviously offers a clear benefit for the patients. Mortality in patients presenting with STEMI and cardiogenic shock is substantially high. For these patients, other concepts regarding timing of surgical revascularisation and bridging until surgery need to be taken into consideration.
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Dmitry
authors.initials: D
authors.lastname: Bobylev
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.forename: Sabina
authors.initials: S
authors.lastname: Guenther
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
authors.forename: Erik
authors.initials: E
authors.lastname: Bagaev
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012372:ROC Curve; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome